Many people with eating disorders focus on food, but the roots often run much deeper
Standing at the stove, I’m making dinner while texting a coworker. She asks how my day’s going. I reply, “Fine, just cooking dinner.” Then I pause—if I weren’t cooking, what would I be doing in the kitchen at 8 p.m.? Most likely, I’d still be there. Maybe opening the fridge, closing it, opening it again. Just standing.
The kitchen at night is a unique space. It’s not a bedroom, not an office. People come here for more than just food.
As a psychologist specializing in eating disorders, I hear the same request at nearly every first session: “Help me fix my eating.” Early in my career, I thought that was my job. Now, I see it differently.
Food is a symptom, not the real request.
On the surface, working to “fix eating” and treating an eating disorder can look similar. In reality, they’re very different.
What the Transdiagnostic Model Shows
In 2003, Fairburn and colleagues described eating disorders as rooted in a central cognitive psychopathology: self-worth built around controlling shape, weight, and food. This is the foundation for Enhanced Cognitive Behavioral Therapy (CBT-E), which has strong evidence behind it, including a meta-analysis by Linardon and colleagues covering 79 randomized controlled trials.
The expanded protocol adds four key maintaining mechanisms:
- clinical perfectionism,
- low self-esteem,
- interpersonal difficulties,
- emotional intolerance.
None of these are directly about food.
Food as a Language
Alexithymia—the difficulty in noticing and naming one’s own emotions—is significantly higher in people with eating disorders, according to a meta-analysis by Westwood and colleagues (48 studies). This holds true across all subtypes: anorexia, bulimia, binge eating. In practice, I see that many people lack the tools to recognize or describe what’s happening inside. But food is always there—accessible, reliable, something to lean on. Over time, it becomes a primary language the body uses to communicate with itself.
The Minnesota Starvation Experiment, led by Ancel Keys in 1944, is worth recalling. Thirty-six healthy volunteers underwent severe calorie restriction for six months. Afterward, they developed rituals around food, obsessive thoughts, and marked mood and behavior changes. When the restriction ended, many experienced binge eating and some gained more weight than they’d lost.
This experiment shows that food restriction alone can create symptoms that look like an eating disorder—even in people with no prior issues. Hunger and restriction are independent factors that can trigger these patterns. In treatment, this means the emotional and food-related sides aren’t alternatives—they’re two ends of the same story.
“But the Request Is About Food”
The request sounds like it’s about food, and that’s where the work begins. Not in spite of this, but because of it.
For the first two or three sessions, I review eating patterns with my client—not as a nutritionist, but as an observer. We use a structured self-monitoring form, tracking not just what and when, but also where and in what context. Feelings and thoughts come later; at first, it’s just the events.
After two or three weeks, the conversation usually shifts. Sometimes sooner, sometimes later, but it always happens. Not because I steer it, but because the records reveal patterns: episodes aren’t random. They follow a day without food, a specific person, or a certain state the client can’t yet name. Hunger is usually part of the picture, but it’s just one factor.
Food is a symptom, not the request. It’s simply the most visible place to start.
What About Weight?
Before discussing weight, a quick note on diets. In a 1999 Australian prospective study by Patton and colleagues, girls aged 14–15 on strict diets developed eating disorders 18 times more often than those not dieting. Even moderate dieting raised the risk fivefold. “Diet” and “eating disorder prevention” are not the same.
Weight itself is another layer. A meta-analysis by Anderson and colleagues (29 studies) found that five years after a structured weight-loss program, the average participant kept off less than 3% of their starting weight. Long-term, diets rarely work.
If I use weight as a progress marker in therapy, I’m reinforcing the same logic that brought the client to me in the first place.
One caveat: this framework applies to binge eating and bulimia. In anorexia nervosa, weight isn’t a progress marker, but it’s not neutral either. When someone is severely underweight, restoring weight is a medical necessity, not a negotiation.
When Change Becomes Visible
Over the years, I’ve found a simple signpost. When a client is home alone in the evening and, for the first time, notices she has a choice: she can go to the kitchen or not, and both options feel equally possible. That’s when therapy has reached the core.
Before that, there’s no real choice. The kitchen at night is often the only place to be alone, without roles, expectations, or the need to perform. People don’t go there out of hunger. They go because no other doors to themselves have opened yet.
Therapy doesn’t close the kitchen. It opens other doors. The kitchen becomes just one option, not the only route.
Food is a symptom, not the request.
In my next article, I’ll explore what binge eating isn’t—and why differential diagnosis at the first session makes ongoing work much easier for both therapist and client.
I work online with anorexia nervosa, bulimia, and binge eating disorder. For more on my approach and to schedule a session, visit anyamalets.ru.
